Support is requested for a study comparing response to treatment in terms of dropout, subsequent service and substance use, and the cost of service use, suicidality, in ADM adolescents and pure substance abusing adolescents attending specialist substance abuse treatment programs at a publicly funded Community Guidance Clinic (CGC), and a private Day Hospital (Teer House) treatment facility. Both of these settings are part of the clinical services of the Division of Child and Adolescent Psychiatry of the Department of Psychiatry at Duke University Medical Center, Durham, NC. The presence of substance abuse and psychiatric disorders in the parents and other adult relatives of the adolescent proband will also be evaluated in order to determine whether these problems are reflected in increased suicidality and increased psychiatric, medical, social services or legal service use by the adolescents. METHODS: 150 consecutive CGC and 100 consecutive Teer House adolescents and their families will be recruited at presentation to the two facilities. The adolescent proband will be interviewed about their psychiatric status and substance use over the preceding 3 months using a semi-structured interview (CAPA). They will also complete ratings of their family environment questionnaire (Harler self-concept scale and FAM). Their parents will complete diagnostic interviews pertaining to their own and their family members' psychiatric status (CIDI, FH-RDC and CAPA), and service use over the preceding 4 months. They will also complete a self-rating scale of their family environment (FAM). Follow-up evaluations will be completed at 4,8,12,18, and 24 months, that will document the adolescent's treatment and psychiatric status, use of drugs and alcohol and use of services. Ratings of service use will be extended by perusal of service providers' records.